Apparatus for treatment of the spinal column



y 4, 1954 F. Li KNOWLES 2,677,369

APPARATUS FOR TREATMENT OF THE SPINAL COLUMN Filed March 26, 1952 IN VENTOR.

Fred L Know/es A TTOR NE Y Patented May 4, 1954 APPARATUS FOR TREATMENTOF THE SPINAL COLUMN Fred L. Knowles} Fort Dodge, Iowa Application March26, 1952, Serial No. 278,596

The present invention relates to a method and an articl of manufacturefor use in relieving an unstable low back.

An unstable low back in humans may be caused by one or more of a numberof different factors.

In any event, it is a damage to the spine, generally the lower lumbarand sacral area, that portion immediately adjacent to the sacrum, andusually is accompanied by substantial pain.

Various practices for giving relief from this condition are used atpresent. All or part of the injured inter-vertebral disc may be removed.A laminectomy may be performed, or a spinal fusion may be used to giverelief. None of these practices are simple and some require considerableskill. Where a spinal fusion is made it is not uncommon for the patientto be required to be inactive for a period of six months or more. Theprincipal object of the present invention is to make possibl a simplemethod and apparatus for use in treating such a condition. It is simplenot only in the sense that the surgery performed upon the patient isnominal and the patients recovery will be accomplished within a verybrief period of time, but also the blocks which parent from thefollowing description taken in conjunction with the drawings in whichFig. 1 is a side view of the lower portion of the spinal column;

Fig. 2 is a section taken at line 2-2 of Fig. 1;

Fig. 3 is a perspective view of a preferred embodiment of the block ofthis invention; and

Fig. 4 is an end view ofa block illustrating an alternative form of headtherefor.

In some people the upper face 10 of the sacrum ll (Fig. 1) assumes arelatively vertical position with the result that the weight carried bythe spine, generally I2, tends not to be securely supported on thesacrum I I. In many such cases the inter-vertebral facets l3 (Fig. 2) ofthe bones of the spine I2 may ride on each other excessively, causingpain to the individual.

In other instances there may be a traumatic degeneration of the spinaldiscs. This most often occurs to the disc l5 between the sacrum I! andthe fifth lumbar vertebra [6. However, it may occur to other discs, suchas disc ll between the fourth lumbar vertebra l8 and the fifth lumbarvertebra l6.

Continued degeneration of a disc may result in a bulging of the disc,such as is illustrated at I9 6 Claims. (01. 128-92) I in Fig. l, and apressing against the spinal cord or cauda equina (Fig. 2). In extremecases there may be a rupture of the inter-vertebral disc with a portionof the nucleus thereof being extruded into the canal occupied by thespinal cord or its lower prolongation, the cauda equina. Either islikely to produce a sensation of pain in the lower parts of the bodybecause of the pressure on the nerves of the spinal cord.

An unstable low back may involve damage to the inter-vertebral facets [3or to the intervertebral discs, such as [5 or H, or both. Other factors,such as nutritional disturbances, may be an element in producing thecondition that is diagnosed as an unstable low back.

While the present practices for treating this condition will usuallyprovide relief, those practices will often involve rather extensiveoperational procedures. In addition, th period of enforced inactivitymaybe long. By employing the present invention all this is eliminated orgreatly reduced.

I have discovered that by forwardly flexing the spine as far aspossible, blocking apart the posterior processes situated above andbelow the point of injury, and returning the spine to the normalposition the weight carried on the spine is leveled out at theinter-vertebral disc and facets at that point and transferred to theposterior processes. This relieves the pain and encourages the body torepair the injured members. To this end I have devised a block,generally 24, for insertion at the point of injury. Its use will bedescribed on the basis of its insertion between the top 25 of the rearof the sacrum H and the posterior process 26 of the fifth lumbarvertebra l6, inasmuch as this is the most common point of trouble. Itwill be apparent that the block (and the method of its insertion at thefifth lumbar vertebrae) maybe usedbetw'een the posterior process 26 andthe posterior process 21 of the fourth lumbar vertebra It, or elsewhere,depending upon the point of injury.

Block 24 should be formed of a material that will be tolerated by thehuman body. A stainless steel alloy of coba1t,.chromium, and molybdenumsuch as that sold under the name of Vitallium may be used. Otherstainless steels such as the common 18% chromium and 8% nickel alloy maybe acceptable. Certain plastics are also tolerated by the body and maybe used.

The two ends 29 and 8B of block 24 are identical and each has recessmeans in the form of a groove 3! thereacross, with the two grooves beingparallel to each other. The proportions of the grooves 3| are such as tocause the sides of the groove to fit snugly about the upper rear 25 ofthe sacrum II or posterior process 26 when the block is insertedtherebetween with the grooves 3| parallel to the longitudinal axis ofthe posterior process. A groove three-sixteenths of an inch wide andone-eighth of an inch deep has been found to be suitable for mostpurposes.

Transverse to grooves 31 are a pair of shallow grooves 33 and 34 formingteeth 35, 36, and 31 across each of ends 29 and 30. The teeth are forengaging the processes or sacrum, as the case may be, to hold th block24in place, particularly during the period while the ligament isbuilding up about the block. The configuration and size of thetransverse grooves and thus of the teeth is not particularly important.In the illustrated embodiment the transverse grooves 33 and 34 are aboutthe same width as the grooves 3i and about one-fourth as deep.

7 Other types of grooves and teeth may be used, as for example thoseillustrated in Fig. 4. There a plurality of circular grooves 39 formteeth 40 in the end 29 of the block. In some instances it will bepossible to completely dispense with the use of such teeth.

Preferably the blocks 24 are formed with concave sides 42 of generallycircular configuration. This aids in grasping the blocks at the time ofuse. Also it reduces the sharp edges presented to the ligaments thatgrow around it.

It will be found to be desirable to have the blocks made up beforehandin an assortment of sizes. In most cases a set of blocks of sizesranging from one-quarter of'an inch in length, as measured between thebottoms of grooves 3|, to one inch in length, in steps of one-sixteenthof an inch, will be adequate. The ends 29 of the blocks illustrated areone-half of an inch square.

Before one undertakes to-insert the blocks, it is desirable to X-ray thepatient with the spine in forward flexure to make sure that theposterior process will open at the point where it is desired to insertthe block. To insert the blocks the spine is placed in extreme forwardfiexure and the skin separated at the point where the block is to go.The ligaments'between" the posterior process at that point are cut awayand theavailable distance-between the adjacent portions of the posteriorprocesses is determined.

A block is selected which will fit tightlybetween the processes. It isslid into place with the grooves 3! aligned'with the longitudinal axisof the processes. Preferably the blockshould be snug and if necessary itcan be tapped intoplace.

Theincisionis closed and the spine returned to the normal position. Thestraightening of the spine causes theposterior processes to bear againstthe ends of the block with the result that the load carried by the spineis shifted from the facets and disc to the posterior processesv andblock.

The foregoing description of a specific embodi-s. ment is for thepurpose of complying with 35 U. S. C. 1 2 and should not be construed asim posing unnecessary limitations on the. appended claims.

I claim: I

1. A block for insertion between two adjacent posterior spinousprocesses, said block having recess means at opposite ends of the blockadapted to form seats for the adjacent portions of said two processes,said block also having bone engaging means on said ends thereof.

2. A block for insertion between two adjacent posterior spinousprocesses, said block having recess means at opposite ends of the blockadapted to form seats for the adjacent portions of said two processes,the distance between said seats being between about one-quarter of aninch and about one inch.

.3. A block for insertion between two adjacent posterior spinousprocesses, said bloc-k having recess means at opposite ends of the blockadapted to form seats for the adjacent portions of said two processes,the distance between said seats being between about one-quarter of aninch and about one inch,;said block being formed of a rigid materialtolerated by body tissues.

4. A block for insertion between two adjacent posterior spinousprocesses, said block having means to engage the processes including agroove on each end of the block, said-grooves being generally coplanar,said grooves forming seats for the adjacent portions of said twoprocesses, the distance between said seats being between onequarter ofan inch and one inch.

5. A block for insertion between two adjacent posterior spinousprocesses, said block having a groove on each end of the block, saidgrooves being generally coplanar, said grooves forming seats for theadjacent portions of said two processes, the distance between said seatsbeing between one-quarter of an inch and one inch, said block beingformed of a material tolerated by body tissue, said block having atleast two grooves across the ends thereof transverse to said firstmentioned grooves thereby forming teeth to engage the processes toprevent the block from slipping out of place.

6. A block for insertion between two adjacent posterior spinousprocesses, said block having recess means at opposite ends of the blockadapted to form seats for the adjacent portions of said two processes,said block also having bone engaging means on said ends thereof, saidblock being formed of a rigid material tolerated by body tissues.

References Cited in the file of this patent UNITED STATES. PATENTSNumber Name Date 1,401,056 Doyle Dec. 20, 1921 1,973,240 Werness et a1Sept. 11, 1934 OTHER REFERENCES Catalog of Zirnmer Mfg. C0,, Warsaw,Ind, 1947, p. 40. (Copy in Div. 55'.)

Lumbar Disc Lesions, a book by J. R. Armstrong, published in London in1952, pp. 188-191,. (Copy in Div. 55.)

